Neurosarcoidosis: a clinical approach to diagnosis and management
File(s)
Author(s)
Ibitoye, RT
Wilkins, A
Scolding, NJ
Type
Journal Article
Abstract
Sarcoidosis is a rare but important cause of neurological morbidity, and neurological symptoms often herald the diagnosis. Our understanding of neurosarcoidosis has evolved from early descriptions of a uveoparotid fever to include presentations involving every part of the neural axis. The diagnosis should be suspected in patients with sarcoidosis who develop new neurological symptoms, those presenting with syndromes highly suggestive of neurosarcoidosis, or neuro-inflammatory disease where more common causes have been excluded. Investigation should look for evidence of neuro-inflammation, best achieved by contrast-enhanced brain magnetic resonance imaging and cerebrospinal fluid analysis. Evidence of sarcoidosis outside the nervous system should be sought in search of tissue for biopsy. Skin lesions should be identi- fied and biopsies taken. Chest radiography including highresolution computed tomography is often informative. In difficult cases, fluorodeoxyglucose positron emission tomography and gallium-67 imaging may identify subclinical disease and a target for biopsy. Symptomatic patients should be treated with corticosteroids, and if clinically indicated other immunosuppressants such as hydroxychloroquine, azathioprine, cyclophosphamide or methotrexate should be added. Anti-tumour necrosis factor alpha therapies may be considered in refractory disease but caution should be exercised as there is evidence to suggest they may unmask disease.
Date Issued
2016-11-22
Online Publication Date
2016-11-22
2017-10-30T10:18:34Z
Date Acceptance
2016-11-07
ISSN
0340-5354
Publisher
Springer Verlag
Start Page
1023
End Page
1028
Journal / Book Title
Journal of Neurology
Volume
264
Issue
5
Copyright Statement
© The Author(s) 2016. This article is published with open access at Springerlink.com
Subjects
Science & Technology
Life Sciences & Biomedicine
Clinical Neurology
Neurosciences & Neurology
Sarcoidosis
Neurosarcoidosis
Diagnosis
Treatment
Management
NERVOUS-SYSTEM SARCOIDOSIS
THERAPY
MANIFESTATIONS
INFLIXIMAB
SERIES
SIGNS
1103 Clinical Sciences
1109 Neurosciences
Neurology & Neurosurgery
Publication Status
Published